Vancomycin

Vancomycin

[1 vial $5.04]

ADMINISTRATION ROUTES:

  • IV

ALTERNATIVE NAMES:

  • Vancomycin

ICU INDICATIONS:

  1. Infections due to susceptible organisms

PRESENTATION AND ADMINISTRATION:

  • IV: 500mg vial powder
    To prepare a standard bag of 1000mg vancomycin in 250ml of 0.9% sodium chloride: Reconstitute 2 vials of 500mg of vancomycin (each 500mg vial of vancomycin with 10ml of Water for Injection). Add reconstituted solution of vancomycin to a 250ml bag of 0.9% sodium chloride (total volume in bag will now be 270ml).
    Administer as per rate outlined in table 2 to give the total dose of vancomycin prescribed in 24 hours.
    e.g. A patient prescribed 3000mg of vancomycin in 24 hours, will require a 1000mg in 250ml of 0.9% sodium chloride approximately every 8 hours to give total daily dose of vancomycin prescribed. Whereas, a patient prescribed 1000mg in 250ml of 0.9% sodium chloride will only require a bag change every 24 hours.
    Note:
    Each infusion bag should be prepared just prior to administration on the ward by nursing staff. Reconstituted vancomycin solutions are only stable for 24 hours after preparation.

DOSAGE:

1. Loading Dose (prescribed on the STAT side of the drug chart)

Table 1:

2. Maintenance Dose (prescribed on the REGULAR side of the drug chart)

  • The continuous intravenous infusion should follow immediately after the loading dose and be based on an estimate of the patient’s renal function as outlined in table 2.
  • Following this the dose of vancomycin will be guided by the vancomycin serum level (see Dosage Adjustment table 3).

Table 2:

*infusion rate is calculated to include the additional volume in the infusion bag following addition of vancomycin.

3. Therapeutic Drug Monitoring & Dosage Adjustments

  • Therapeutic Drug Monitoring:
    Take a vancomycin serum level first thing in the morning the next day (with the morning routine bloods) after starting the infusion. Continue vancomycin infusion at the current rate until the laboratory has reported the vancomycin serum level.
    Once the vancomycin serum level has been received, use table 3 below to adjust the vancomycin infusion rate and dose if necessary.
    Levels must be done daily and after any change in dose until 2 consecutive measurements in the target range.
    Following this a level is only required weekly or if the creatinine or body weight changes by ≥ 10%.
  • Levels:
    After any change in dose has occurred ensure you ALWAYS re-check level in the morning the next day.
  • Note: Once 2 consecutive levels within the target range have been achieved then the total daily dose of vancomycin may be administered over 24 hours in 1L of sodium chloride 0.9%. Contact your ward pharmacist if your patient is fluid restricted.

Note: Ensure 24 hours of treatment has been administered prior to any dosage adjustment.

Table 3:

# If patient is on 3000mg of vancomycin in 24 hours then contact ID for advice.
** If patient is on 750mg of vancomycin in 24 hours then stop the infusion. Re-check level every 24 hours until the level is < 10mg/L and switch to intermittent dosing or consider alternative agent.

DOSAGE IN PAEDIATRICS:

  • IV: 10mg/kg every 6 hours

CLINICAL PHARMACOLOGY:

  • Glycopeptide antibiotic. The bactericidal action of vancomycin results primarily from inhibition of cell-wall biosynthesis. In addition, vancomycin alters bacterial-cell- membrane permeability and RNA synthesis. Vancomycin has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections: Aerobic Gram-Positive Microorganisms: Diphtheroids. Enterococci (e.g., Enterococcus faecalis) Staphylococci, including Staphylococcus aureus and Staphylococcus epidermidis (including heterogeneous methicillin-resistant strains). Streptococcus bovis. Viridans group streptococci.

CONTRAINDICATIONS:

  1. hypersensitivity to vancomycin

WARNINGS

  • Avoid rapid bolus administration: Rapid bolus administration (e.g., over several minutes) may be associated with exaggerated hypotension, including shock, and, rarely, cardiac arrest.
  • Ototoxicity: Ototoxicity has occurred in patients receiving vancomycin. It may be transient or permanent. It has been reported mostly in patients who have been given excessive doses, who have an underlying hearing loss, or who are receiving concomitant therapy with another ototoxic agent, such as an aminoglycoside.
  • Pseudomembranous colitis: Pseudomembranous colitis has been reported with nearly all antibacterial agents, including vancomycin, and may range in severity from mild to life-threatening. Therefore, it is important to consider this diagnosis inpatients who present with diarrhoea subsequent to the administration of antibacterial agents.

PRECAUTIONS

  • General:
    In order to minimize the risk of nephrotoxicity when treating patients with underlying renal dysfunction or patients receiving concomitant therapy with an aminoglycoside, serial monitoring of renal function should be performed and particular care should be taken in following appropriate dosing schedules
    Reversible neutropenia has been reported in patients receiving vancomycin
    Flushing of the upper body may occur with IV infusion ‘red man syndrome’. This reaction is extremely rare when vancomycin is given over an appropriate time interval. (see PRESENTATION AND ADMINISTRATION)
  • Laboratory Tests: See DOSAGE
    Spec Collection: EDTA (mauve) or Plain (Red) (NOT Heparin(Green))
    Sample Handling: 200 uL serum
    Paediatric and Neonatal only: 0.4 mL Plain (Red) or EDTA (mauve) microtainer. Green NOT suitable.
  • Drug/Laboratory Test Interactions: None known

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • Administration with other nephrotoxic drugs such as aminoglycosides increases the risk of renal toxicity.

ADVERSE REACTIONS

  • Body as a Whole: Anaphylaxis, drug fever, chills
  • Cardiovascular: Hypotension (particularly with rapid injection)
  • Gastrointestinal: Nausea, pseudomembranous colitis
  • Skin: Toxic epidermal necrolysis, rashes (including exfoliative dermatitis),
  • Renal: Nephrotoxicity
  • Haematological: Neutropenia, eosinophilia, thrombocytopenia Otological: Hearing loss, vertigo

Critical Care Drug Manual

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